Public Disclosure Authorized
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WATER AND SANITATION PROGRAM: WORKING PAPER
Nudging and Habit Change
for Open Defecation:
New Tactics from
Behavioral Science
David Neal, Ph.D. (Catalyst), Jelena Vujcic, M.P.H. (Catalyst),
Rachel Burns Ph.D. (Catalyst), Wendy Wood, Ph.D. (University of
Southern California) and Jacqueline Devine, MBA (World Bank,
Public Disclosure Authorized
Water and Sanitation Program)
March 2016
Authors: David Neal, Ph.D. (Catalyst), Jelena Vujcic,
M.P.H. (Catalyst), Rachel Burns Ph.D. (Catalyst), Wendy
Wood, Ph.D. (University of Southern California) and
Jacqueline Devine, MBA (World Bank, Water and
Sanitation Program).
The Water and Sanitation Program is a multi-donor partnership,
part of the World Bank Group’s Water Global Practice,
supporting poor people in obtaining affordable, safe, and
sustainable access to water and sanitation services. WSP’s
donors include Australia, Austria, Denmark, Finland, France,
The Bill & Melinda Gates Foundation, Luxembourg, The
Acknowledgements
This report was produced in collaboration between
Catalyst Behavioral Sciences and the World Bank Water
and Sanitation Program (WSP).
Netherlands, Norway, Sweden, Switzerland, United Kingdom,
United States, and the World Bank.
Disclaimer
The findings, interpretations, and conclusions expressed herein
We gratefully acknowledge the expert input of Markus
Brauer, Yolande Coombes, Craig Kullmann, Robert
Dreibelbis, Francesca Gino, Steve Luby, Hans-Joachim
Mosler, Mushfiq Mubarak, Nila Mukherjee, Mike
Norton, Katherine O’Connell, Julia Rosenbaum, Jan
Willemn Rosenboom, Kathleen Vohs, and Viengsamay
Vongkhamsao.
are entirely those of the author and should not be attributed to
the World Bank or its affiliated organizations, or to members
of the Board of Executive Directors of the World Bank or
the governments they represent. The World Bank does not
guarantee the accuracy of the data included in this work. The
boundaries, colors, denominations, and other information
shown on any map in this work do not imply any judgment on
the part of the World Bank concerning the legal status of any
The report was designed by Katy Martinez of Ruttle
Design. Penny Scudder acted as project manager
and editor.
territory or the endorsement or acceptance of such boundaries.
Copyright Statement
The material in this work is subject to copyright. Because
The World Bank encourages dissemination of its knowledge,
this work may be reproduced, in whole or in part, for
noncommercial purposes as long as full attribution to the
work is given.
© 2015 International Bank for Reconstruction and
Development/The World Bank
Contents
Contents
I.
II.
Introduction ................................................................................. 1
Global Prevalence and Persistence of OD .................................. 1
Current Behavior Change Strategies for OD .............................. 1
A Brief Primer on Habits and Nudges: System 1 Tactics for ........
Behavior Change ....................................................................... 2
How Can System 1 Derail Behavioral Interventions .................... 3
Way Forward: Augmenting OD Interventions with Nudges
and Habit Change Tactics .......................................................... 4
Methodology for Arriving at the Principles .................................. 4
The 8 Principles ........................................................................... 6
Principle 1:
STRATEGICALLY INCREASE/DECREASE THE PHYSICAL .........
AVAILABILITY OF KEY PRODUCTS AND INFRASTRUCTURE ... 6
Relevance to OD: ....................................................................... 6
Principle 2:
LEVERAGE CONTEXT CHANGE ............................................... 8
Relevance to OD: ....................................................................... 8
Principle 3:
PIGGYBACK ON EXISTING CUES AND BEHAVIORS .............. 10
Relevance to OD: ..................................................................... 10
Principle 4:
REDUCE PERCEIVED AND ACTUAL FRICTION FOR NEW
BEHAVIOR / ADD FRICTION TO THE OLD .............................. 12
Relevance to OD: ..................................................................... 12
Principle 5:
SUPPORT CONTEXT-STABLE REPETITION ............................ 14
Relevance to OD: ..................................................................... 14
Principle 6:
ADDING “RITUALIZED” ELEMENTS TO THE INTERVENTION
CAN ENHANCE EFFECTIVENESS AND ADVOCACY............... 16
Relevance to OD: ..................................................................... 16
Principle 7:
LEVERAGE REMINDERS AND INTENTIONAL CUES ............... 18
Relevance to OD: ..................................................................... 18
Principle 8:
LEVERAGE DESCRIPTIVE AND “LOCALIZED” NORMS .......... 20
Relevance to OD: ..................................................................... 20
III. Concluding Remarks ................................................................. 22
REFERENCES ........................................................................... 24
www.wsp.org
iii
Executive Summary
Executive Summary
Open defecation (OD) remains a critical global health
challenge, affecting almost 1 billion people around the
world and contributing significantly to the estimated
842,000 people who die each year because of poor
sanitation, hygiene practices, and unsafe water supplies
(WHO, 2014).
To date, most behavior change frameworks for addressing
OD have focused on relatively conscious, “reflective”
drivers of behavior, including people’s emotions (e.g.,
pride, shame), rational knowledge (e.g., of germ theory),
social norms, and explicit action plans (e.g., commitments
to change; see Sigler, 2014).
Using the framework popularized by Kahneman (2011),
these factors can be described as “System 2” drivers of
behavior (i.e., relatively conscious and motivational
factors). It is now well established, however, that human
behavior can also be heavily influenced by “System 1”
drivers (i.e. relatively automatic, cue-driven drivers;
Marteau et al., 2012; Wood & Neal, 2015). System 1
factors of particular relevance to OD include people’s
hygiene habits (e.g., mindlessly repeated behaviors cued by
context) and “nudges” (i.e., small changes to the
environment that can channel decision making and
behavior in new ways, Thaler & Sunstein, 2008).
In this working paper, we draw on basic scientific findings
from psychology, cognitive science, and behavioral
economics to propose a framework of 8 System 1
Principles to support the initiation and maintenance of
OD behavior change. In doing so, we build from the
general framework advanced in the World Bank Group’s
(2015) World Development Report: Mind, Society, and
Behavior, which emphasized three core insights from
behavioral science, namely that people think (a)
automatically, (b) socially and (c) using mental models
that channel their decision-making.
iv
The 8 principles were developed through an iterative
process involving (a) thematic coding of field research
findings regarding OD, (b) identification of potential
behavioral science principles matched to the themes
identified in the field research, (c) consultation with 9
sanitation and hygiene experts with extensive experience in
OD interventions around the world, and (d) consultation
with 7 academic behavioral scientists with expertise related
to each principle. The process culminated with the
development of a simple summary and activation guidance
for each principle.
The 8 System 1 Principles to support the initiation and
maintenance of OD behavior change behavior change are
as follows:
1. Ensure critical products and infrastructure are
immediately and consistently physically available for
the end user.
• Example: Promote latrine construction at secondary
locations (transit, markets), so that new latrine use
habits are not disrupted.
2. Create or capitalize on context change to drive new
behavior of toilet use.
• Example: Capitalize on seasonal migration patterns
or other events that disrupt existing behaviors –
time interventions to co-occur with these shifts.
3. Piggyback on other existing behaviors and cues.
• Example: Build community latrines that piggyback
on existing established behaviors in a community
(e.g., washing clothes, water gathering).
4. Strategically increase friction for the undesired
behaviors and lessen it for desired ones.
• Example: Promote pre-packaged options
(e.g., “Easy Latrines” in Cambodia) that simplify
the latrine construction process.
Nudging and Habit Change for Open Defecation: New Tactics from Behavioral Science
Executive Summary
5. Support context-stable repetition for latrine use.
• Example: Reward context-stable use of community
latrines (reward repeated use at the same place and
time, at least initially).
6. Embed ritualized elements in the change process.
• Example: Integrate OD messaging into already
ritualized cultural practices (e.g., “no loo, no bride”
campaign in India).
7. Leverage point-of-action reminders and cues.
• Example: Create salient cues at typical OD sites to
act as reminders that these physical spaces have a
new meaning (e.g., use vermillion powder to
ritually cleanse the site).
8. Highlight descriptive and “localized” norms that reduce
cognitive demands.
• Example: Develop and frame incentive systems in
ways that work at the level of a local group
(e.g., local village or women’s group), rather than
individuals or entire area.
www.wsp.org
We emphasize that these 8 principles are meant to
augment, not replace, approaches based on System 2
thinking. A core insight from the behavioral sciences (see
Kahneman, 2011) is that human behavior is the product
of both System 2 thinking (rational, motivated) and
System 1 thinking (automatic, cue driven habits). Thus,
the most challenging behavior change problems will
invariably require a set of targeted System 1 and System 2
tactics working in unison.
Finally, as field practitioners explore folding these ideas
into OD interventions, we encourage the use, where
practical, of randomized control trials (RCTs), the robust
measurement of outcome data, and the sharing of
successes and failures alike. In particular, we encourage the
sharing of new ways to translate, tailor, and “bring to life”
these basic science principles as makes sense in specific
environments, cultures and sub-populations.
v
Foreword
Foreword
Rich and poor alike, people sometimes act in ways that
undermine their own health and well-being. After all,
humans are creatures of habit, and many of our daily
actions run on auto-pilot with limited conscious thought.
Until recently, this aspect of human behavior, often called
“System 1 thinking,” was largely off-limits for
development practitioners. We simply knew too little
about the cognitive biases and mechanisms that govern
System 1 thinking and we lacked practical tools for
applying them to real-world development challenges.
Fortunately, that is beginning to change.
In 2015, the World Development Report: Mind, Society
and Behavior, summarized a wide range of new scientific
findings on ways to “nudge” and trigger positive behavior
change by leveraging automatic thinking, social influence,
and mental models. As the WDR showed, these
approaches show high potential in shifting behaviors as
diverse as corruption, parental caregiving practices,
household savings, and conservation, among many others.
vi
In that spirit, Nudging and Habit Change for Open
Defecation could not be more timely and valuable. This
Working Paper tackles one of our most pressing sanitation
challenges—and one that has proven especially resistant to
traditional, rational tactics such as information-based
interventions. By carefully marrying academic findings
from behavioral science with field-based insights from
sanitation experts, the report creates a powerful blueprint
for new intervention tactics that are evidence-based yet
practical. I look forward to seeing how the eight System 1
principles described in the following pages inspire new
progress in creating and maintaining change in open
defecation practices.
Varun Gauri, Ph.D.
Head, Global Insights Initiative (GINI)
The World Bank
Nudging and Habit Change for Open Defecation: New Tactics from Behavioral Science
I.
Introduction
Global Persistence of
Open Defecation (OD)
Approximately 2.4 billion people around the world lack
access to improved sanitation facilities and just under 1
billion people engage in open defecation (OD; WHO/
UNICEF 2015). Poor sanitation, in turn, drives a range of
diseases, including diarrhea, trachoma, and soil-transmitted
helminth infections (Pruss-Unstun et. al 2008). Diarrhea
alone has a devastating impact on child morbidity and
mortality, especially in low-income settings; it accounts for
approximately 800,000 deaths of children under 5 years of
age each year (Liu et al., 2012). Although the challenges
associated with OD are global in nature, they are especially
prevalent in India, which accounts for roughly two-thirds of
the global OD population and one-third of those without
improved sanitation facilities (WHO/UNICEF 2015).
In 2000, The United Nations Millennium Development
Goals (MDGs) established a target of halving the global
population that lacks access to safe water and improved
sanitation. Between 1990 and 2015, approximately 2
billion people gained access to improved sanitation, but
OD practices have proven especially difficult to change
(Millennium Development Report, 2014). The sanitation
component of the MDG is currently expected to fall short
by at least 500 million people (WHO, UNICEF 2014).
described as “System 2” drivers of behavior (i.e., relatively
conscious and motivational factors).
As an example of a primarily System 2 approach to OD,
Community-Led Total Sanitation (CLTS) interventions
engage the community in a process of conscious selfrealization that leverages shame, pride, and concrete action
planning to move people towards OD free (ODF) status
(Sigler, 2014). Similarly, the SaniFOAM behavior change
framework (Devine, 2009) focuses primarily on identifying
factors related to opportunity, ability and motivation
that influence sanitation behaviors such as OD. These can
be regarded as principally, although not exclusively,
System 2 strategies.
These approaches have achieved some marked success and
they incorporate the very best tactics currently known to
promote OD change. However, even with these tools,
many attempts to alter OD in the field still fail, or achieve
only short-term success that does not “stick” or maintain
over time (see Sigler, 2015).
Current Behavior Change Strategies for OD
The persistence of OD is complex and multi-determined,
encompassing a mix of supply-side issues (e.g., access to
latrines, affordable building materials) and demand-side,
or “user-centered,” issues (e.g., cultural and religious beliefs,
relative convenience and affordability of OD; for a recent
review, see O’Connell, 2014).
In this report, we propose that further advances can be
made by incorporating new insights about the role that
habits, nudges and other “System 1” drivers (i.e., relatively
automatic and non-conscious factors) play in supporting
and sustaining behavior change (Marteau et al., 2012;
Thaler & Sunstein, 2008; Wood & Neal 2015). In doing
so, we build from the general framework advanced in
the World Bank Group’s World Development Report
(WDR, 2015), which emphasized three core insights
from behavioral science, namely that people think (a)
automatically, (b) socially and (c) using mental models that
channel their decision making.
To date, most of the demand-side interventions and
frameworks for OD have emphasized relatively conscious,
“reflective” drivers of behavior change, including people’s
emotions (e.g., pride, shame), their rational knowledge
(e.g., awareness of germ/fecal matter transmission), social
norms, and explicit action plans (Sigler et al., 2014).
Popularized by Kahneman (2011), these factors are often
In the following pages we propose 8 high potential System
1 Principles to support the initiation and maintenance
of OD behavior change. In brief, these principles were
generated through a multi-stage process beginning with a
review of qualitative and quantitative research findings from
the OD field literature. We then mapped recurring themes
from the field literature to evidence-based behavior change
www.wsp.org
1
Introduction
tactics from behavioral science, including social psychology,
behavioral economics, and cognitive science. The principles
were then vetted, refined, and given executional detail
through structured interviews with a team of 7 academic
experts and 8 sanitation and hygiene experts. Our process is
described in more detail in the Methodology section below.
In the following pages, we provide a brief overview of
System 1 versus reflective System 2 thinking, focusing on
habit change and nudging. We then describe each of the 8
System 1 Principles, including the supporting basic science
and examples of successful applications in real world
settings. We also unpack the ways these principles (a) map
to consistent patterns seen in OD behavior around the
world, (b) inspire specific new OD intervention tactics, and
(c) can be folded into existing program activities commonly
used in OD behavior change.
A BRIEF PRIMER ON HABITS AND NUDGES:
SYSTEM 1 TACTICS FOR BEHAVIOR CHANGE
In recent decades, great advances have been made in the
scientific study of behavior change. One key innovation
has been the discovery that many factors can significantly
impact people’s behavior, yet bypass their conscious
decision-making, attitudes, goals, and awareness (e.g.,
Ariely, 2009; Thaler & Sunstein, 2008; Wood & Neal
2007; WDR, 2015).
BOX 1: HABITS AND NUDGES
• Habits Frequent, learned behavioral responses
that are cued automatically by context cues, such
as physical settings and preceding actions in a sequence (e.g., morning bathing sequence, food preparation habits, daily travel.
• Nudges Environmental cues that signal a desired
response from the end user or channel their decision
making (e.g., placing fruit at eye level to encourage
consumption, changing defaults so that people have
to deliberately opt-out of healthy behaviors).
2
These processes are actively studied in multiple academic
fields, including social psychology (e.g., Kahneman, 2011;
Wood & Neal, 2007), behavioral economics (e.g., Thaler &
Sunstein, 2008), cognitive neuroscience (e.g., Marteau et
al., 2012) and health psychology (Rothman et al., in press).
Each of these disciplines has its own nuances and
terminology, but all of them emphasize that drivers of
human behavior can be grouped into:
• A more conscious, goal-directed system that
uses decision-making to direct behavior towards
emotionally and motivationally valued outcomes.
This system is called System 2.
• A more automatic, cue-driven system that uses
familiar behavior patterns, signals from the
environment, and simple decision rules (e.g.,
heuristics) to guide behavior. This system is called
System 1.
Most of the time, these two systems work together
harmoniously and efficiently (Kahneman, 2011). System 2
allows us to consciously monitor and carefully establish new
behaviors, and ensures that these new behaviors meet our
goals. Once a stable behavioral pattern is set up and
repeated, we spontaneously engage System 1, which allows
us to redirect our limited attention, willpower, and goal
setting elsewhere.
Sometimes, however, System 1 and System 2 come into
conflict and push behavior in different directions. This
phenomenon is powerfully illustrated by behavior
prediction studies. Typically, these studies focus on a
specific behavior (e.g., seat belt use) and measure the
strength of relevant System 2 factors (e.g., people’s goals/
intentions to wear a seat belt) and the strength of relevant
System 1 drivers (i.e., their habits of wearing/not wearing
a belt). The critical question then becomes: which system
is the biggest predictor of what people actually do in the
future? In a meta-analysis of many such studies, Ouellette
and Wood (1998) found the striking pattern depicted
in Box 2.
Nudging and Habit Change for Open Defecation: New Tactics from Behavioral Science
Introduction
BOX 2: IMPACT OF HABITS VS. INTENTIONS ON FUTURE BEHAVIOR
Things we do rarely or in different
environments…
Intentions / Attitudes
Habit Strength
.62
FUTURE
BEHAVIOR
.12
Things we do often and in the
same environment…
Intentions / Attitudes
.27
Habit Strength
.45
FUTURE
BEHAVIOR
Box 2. Behavior prediction pattern reported in Ouellette and Wood’s (1998) meta-analysis. Numbers reflect correlation coefficients (r values). Habit strength reflects the
frequency and context stability of the behavior in past performance. Intentions/attitudes reflect people’s stated preferences about what they wish to do in the future.
Critically, for behaviors that people perform infrequently or
in different settings, System 2 drivers, such as attitudes and
intentions, are stronger predictors of their future behavior.
However, behaviors that are performed frequently in the
same setting are better predicted by habit strength, which
belongs to System 1. This is because System 2 loses its
influence for behaviors that people have performed
frequently and in the same setting and way each time.
As we explain next, these insights set the stage for a deeper
understanding of how System 1 can derail current
intervention efforts to stop OD, and opportunities that
exist to turn System 1 from a liability to an asset in OD
behavior change.
HOW CAN SYSTEM 1 DERAIL BEHAVIORAL
INTERVENTIONS?
As practitioners and researchers know, it is difficult to get
people to change their behavior (Webb & Sheeran, 2006),
and even more difficult to maintain that change over
time (Volpp et al., 2008). Unsuccessful interventions can
generally be classed into those that fail to disrupt behavior
at all (i.e., they achieve no measurable behavior change) and
those that initially change behavior but the changes fail to
stick (i.e., initial behavior change gives way to “relapse”).
System 1 can play a strong role in both of these types of
failures. As we saw above, when people frequently repeat a
behavior in the same setting (e.g., defecation outside) and/
or in the same action sequence (e.g., wake up, then walk,
www.wsp.org
then defecate), control of the behaviors generally will have
shifted away from System 2 to System 1. For this reason,
interventions that focus primarily on System 2 may often
have limited behavioral impact. The intervention will fail
to disrupt because System 1 is in charge of the behaviors
and the intervention is targeting the wrong system.
Demonstrating this, Webb and Sheeran’s (2006) metaanalysis of 47 studies found that interventions targeting
intentions are generally effective at changing behaviors that
people perform infrequently (e.g., blood donation) but are
generally ineffective at changing habits (e.g., seat belt use).
System 1 can also cause relapse—or stickiness failures—for
interventions that initially succeed in changing behavior.
Oftentimes, an intervention will temporarily change
people’s behavior, but this change does not last and people
shortly return to their old behavior (Volpp et al., 2008).
Why does this happen? Learning and memory research
shows that System 1 habits, even when changed, tend not
to be forgotten. Instead, they become dormant in people’s
memory and can be revived relatively easily even after
significant time has passed (Bouton, 2000). Thus, people’s
short-term successes at changing their behavior can fail to
stick because habits re-exert themselves over time, causing
relapse to old ways of acting (Tobias, 2009). This does
not mean that old habits never die. However, they are
remarkably resilient and can re-emerge rapidly when cues
associated with those habits are present.
3
A WAY FORWARD: AUGMENTING OD
INTERVENTIONS WITH NUDGES AND HABIT
CHANGE TACTICS
To summarize, the System 2 tactics that work for new
or infrequently performed behaviors generally will not
successfully disrupt and stick where System 1 is in charge.
Therefore, these tactics need to be augmented with tactics
that target System 1. In the remainder of this document we
introduce 8 principles that have high potential to address
System 1 and create disruptive and lasting change in OD
behavior. Box 3 below summarizes these principles.
METHODOLOGY FOR ARRIVING
AT THE PRINCIPLES
We arrived at the 8 principles via 5 steps. At Step 1,
we collated the peer-reviewed literature (PubMed)
and grey literature (formative research reports and
internal documents from the World Bank’s Water and
Sanitation Program) addressing OD behavior, and latrine
construction, usage and maintenance. We reviewed studies
that reported on specific OD interventions (e.g., CLTS)
as well as studies that were purely descriptive (i.e., did not
involve interventions). This process generated a database
of over 340 specific findings from the field. At Step 2, we
thematically coded the field insights to identify instances
where habits or other System 1 processes might plausibly
underlie, or contribute to, an observed finding. Coding was
performed independently by three expert coders and any
inter-coder differences were resolved through discussion.
At Step 3, we used the behavioral science literature—
including social psychology, health psychology, cognitive
science, and behavioral economics—to identify high
potential strategies for influencing the common themes
that emerged at Step 2. As part of Step 3, we also consulted
BOX 3: 8 SYSTEM 1 PRINCIPLES FOR OD BEHAVIOR CHANGE
Box 3. 8 Principles for Leveraging Nudges and Habit Change Tactics
(System 1) to Support OD Behavior Change.
4
Nudging and Habit Change for Open Defecation: New Tactics from Behavioral Science
a group of basic science experts from academia who study
various System 1 tactics for behavior change (see Table
1 below) This process generated a preliminary list of
approximately 40 principles.
At Step 4, we consulted nine field experts (see Table 2)
with extensive knowledge of OD behavior and intervention
approaches in various regions (e.g., India, South East
Asia and Africa) and settings (e.g., urban, rural, river).
At this point, we refined the list of principles to 8 with
the highest potential. Finally, at Step 5, we created an
TABLE 1: ACADEMIC EXPERTS CONSULTED AT STEP 3
Academic Experts
Areas of Expertise
Prof. Markus Brauer
University of Wisconsin
Social psychology, attitude
change, social influence,
Prof. Robert Dreibelbis
University of Oklahoma
Sanitation and hygiene
behavior change
Prof. Francesca Gino
Harvard University
Psychology, behavioral
economics, ritual creation
Prof. Mushfiq Mobarak
Yale University
Sanitation and hygiene
behavior change
Prof. Mike Norton
Harvard University
Social psychology, behavioral
economics, nudging
Prof. Kathleen Vohs
University of Minnesota
Social psychology, cognitive
science, behavior change
Prof. Wendy Wood
University of
Southern California
www.wsp.org
Social psychology, health
psychology, attitude change
activation plan for each principle, by unpacking examples
of successful implementation in other domains as well as
identifying potential links to existing OD change tactics
and hypotheses about genuinely new actions that could be
taken. These activation ideas were refined in consultation
with the academic and field experts.
TABLE 2: OD, SANITATION AND HYGIENE EXPERTS
CONSULTED AT STEP 4
OD, Sanitation
& Hygiene Experts
Affiliation
Yolande Coombes
Independent
Consultant/World
Bank Group
Craig Kullmann
World Bank
Steve Luby
Stanford University
Nila Mukherjee
Independent
Consultant/World Bank
Hans-Joachim Mosler
EAWAG
Katherine O’Connell
Independent expert/
World Bank
Julia Rosenbaum
FHI360
Jan Willem Rosenboom
The Bill & Melinda
Gates Foundation
Viengsamay Vongkhamsao
World Bank
5
The 8 Principles
II.
The 8 Principles
Principle 1:
Strategically increase/decrease the physical
availability of key products and infrastructure
Principle Overview:
As a necessary, but not sufficient condition for change
- increase the likelihood that supporting products/
infrastructure for latrine use are consistently and
immediately physically available in the environment
(without active searching/effort). Alternatively, or in
addition, decrease the physical availability of products/
infrastructure needed for OD.
Basic Science:
Habits are automatically triggered by context cues,
including physical settings, preceding actions, and times of
day. If these critical cues are not consistently present in the
environment (without active seeking/effort), the desired
habit will not occur unless motivation is extremely high
(Wood, Tam, & Witt, 2005).
Relevance to OD:
Principle 1 captures the basic idea that certain physical
structures and products (e.g. latrines near fields for farm
workers) need to be consistently and easily available to
people if they are to have any chance of changing their
behavior. Importantly, these physical features will be
necessary but not sufficient to initiate behavior change. For
example, findings from a global review of WSP initiatives
in rural settings indicate that, in many countries, people
who have easy physical access to a latrine at home still
engage in OD (O’Connell, 2014). However, maximizing
the consistent physical availability of enabling products
remains a critical first step for new latrine-use habits to
form. Where possible, latrines need to be available not
only at home, but in other contexts and times of day that
are a part of daily life, such as at work, near crop fields, in
public places like markets and in the homes of others. For
example, in rural Cambodia, 2% of adults with access to
latrines at home reported defecating in the open while at
home but when outside of the home, 43% of this same
group practices OD (Cambodia WSP Demand Assessment
6
HOW TO EXECUTE/EXAMPLES OF APPLICATION
Supporting new behavior:
• The consistent physical availability of soap
within easy reach has been found to be critical to
the formation of a new handwashing with soap
practice (Luby, 2009).
• “Lucky iron fish”
(picture to right) used
to treat iron deficiency (http://www.
luckyironfish.com).
Fish is highly “physically available” – can
be kept in cooking pot and removed just before food
is added to automatically dose with iron. Also leverages Principle 3 (piggybacking), 4 (friction) and 5
(context stable repetition).
Undermining existing (unhealthy) behavior:
• Banning visual display of cigarettes (which reduced
the physical availability of cigarettes) at point-of-purchase is effective at reducing impulse/habitual cigarette
purchases (Wakefield, Germain, & Henriksen, 2008).
Report, 2007). OD while working in agricultural fields
is considered typical behavior since there is no access
to sanitation facilities and going home to use a toilet
was perceived as a waste of time (Qualitative Report for
Understanding Rural Sanitation, Bihar, 2012).
Several opportunities to leverage Principle 1 emerged in
the literature we reviewed. First, OD often becomes
difficult to practice (i.e., OD is physically less available)
during rainy season when rain is consistent, roads or
fields are flooded, dry space is constrained, and insects
are more prevalent (WSP reports from Kenya, Indonesia,
Meghalaya, Rajasthan, Bihar). Illness, disability and old age
are also often cited as circumstances when OD is difficult
or impossible to perform (WSP reports from Meghalaya,
Rajasthan, Bihar). Safety at nighttime, and from wild
animals were also cited in a few reports as deterrents of
OD, especially among women (WSP reports from Kenya,
Indonesia, Meghalaya, Rajasthan, Bihar).
Nudging and Habit Change for Open Defecation: New Tactics from Behavioral Science
The 8 Principles
Physical Availability Challenges
Physical Availability Opportunities
• Lack of consistently available sanitation facility (alternative not physically available) at home
and during work creates “gaps” in availability of
latrines.
• Rainy season reduces physical access to OD,
creating opportunity to shift people to latrines.
• Lack of availability of masons and materials to
build, maintain and improve latrines.
• Old age reduces access to OD.
• Structural soundness of latrines (risk of collapse
in rainy season), reducing physical availability of
functional latrines.
• Illness temporarily reduces physical access
to OD and could be leveraged too.
• Safety (night time, wild animals) reduces
access to OD.
• When pit is full and not easily emptied, latrine
becomes “unavailable”, causing relapse to OD.
• In many contexts, plastic bags are highly physically available, leading to use of “flying toilets”.
PROGRAMMATIC IMPLICATIONS 1: MAPPINGS TO RECENT INNOVATIONS/TACTICS
• New product innovations
that ensure OD alternatives
are consistently, easily readily
at hand (e.g., PeePoo bags as
alternatives to “flying toilets”;
http://www.peepoople.com).
• Launching Micro-Finance
Initiatives to support latrine
purchase at the same time
as OD interventions to ensure
alternatives to OD are consistently, immediately at hand.
• Ensuring latrines are
constructed in contexts
beyond the home (e.g.,
transit points, markets,
schools, workplace).
• Examine the potential in a
“total solid waste” strategy
where all waste/trash is in a
given setting is removed (not
just sanitation). Thus, the
physical availability of all
waste is radically altered in an
environment at one time. See
experience in Rwanda, where
a total solid waste strategy
may be demonstrating value
in shifting OD practices.
PROGRAMMATIC IMPLICATIONS 2: NEW IDEAS AND EXTENSIONS
• Micro-Finance Initiatives
that support keeping public
toilets open later at night and
earlier in the morning (thus
increasing physical availability),
when operators would normally
close them because they are
not sufficiently profitable. Thus,
removing disruptions in the
physical availability of latrines.
www.wsp.org
• During OD mapping
activities in CLTS interventions,
opportunities may exist to
reduce the physical availability
of common OD locations in
the village (e.g., repurposing
common OD sites for an
alternative use, barricading usual
OD sites) so they are physically
altered and less physically
available.
• Construct public toilets
before initiating CLTS to
ensure availability of toilets
while households construct
their toilets.
7
The 8 Principles
Principle 2:
LEVERAGE CONTEXT CHANGE
Principle Overview:
Disruptions to the physical environment and/or familiar
action sequences create a “window of opportunity” for a
new habit to form.
Basic Science:
When people undergo major shifts in context or life
circumstances, their existing habits are temporarily
vulnerable to change (see Rothman et al., in press).
Context change can include major shifts in the external
environment (e.g., moving to a new house or area), but
even small context changes can sometimes be enough to
change behavior (Neal, Wood, Wu and Kurlander, 2011).
Thus, a wide array of context shifts can be useful entry
points to support the initiation of a new behavior.
HOW TO EXECUTE/EXAMPLES OF APPLICATION
• Providing free public transport vouchers is more
effective when the vouchers are sent to people
who have recently moved house because their
car-use habits are temporarily disrupted
(Verplanken, Walker, Davis, & Jurasek, 2008).
8
Relevance to OD:
One challenge for Principle 2 is that the physical context
and other daily activities before and after an intervention
like CLTS triggering remain mostly the same. However, we
found several examples from the OD literature that may
present windows of opportunity to leverage Principle 2. As
described under Principle 1, seasonality (especially rainy
season) presents a yearly context change were OD becomes
difficult to practice and presents an opportunity for more
consistent latrine use.
The WSP reports highlight several life stage changes, such
as illness, birth, marriage or receiving a new daughterin-law, having elder or ill household members, as
circumstances where having a latrine is advantageous and
OD temporarily becomes a disadvantage. For example,
those who adopted toilet use reported that marriage of a
son and having a new daughter-in-law was a trigger for
adopting a toilet to avoid humiliation and shame (WSP
report Bihar, 2012). Among this report and others, survey
respondents also indicated that having visitors to their
home, especially those that are accustomed to using toilets,
was a motivator for toilet adoption to avoid shame or to
improve social status (WSP reports Bihar, Meghalaya,
Malawi).
Nudging and Habit Change for Open Defecation: New Tactics from Behavioral Science
Context Change Challenges
Context Change Opportunities
• Physical context and other daily activities remain
mostly the same pre/post CLTS triggering.
• Seasonal changes (physical context).
• Life stage changes, illness, birth (i.e., many new
action sequences), marriage or receiving a
new daughter-in-law, having visitors, having
elders or those who are sick in the home.
PROGRAMMATIC IMPLICATIONS 1: MAPPINGS TO RECENT INNOVATIONS/TACTICS
• Capitalize on “circular migration” patterns to disrupt OD practices while people are temporarily
away from their home environment (e.g., seasonal worker migration, major holiday migration such
as Pchum Benh in Cambodia). They will be more likely to change when away from home and
may bring their new “latrine habits” back to their home environment. See Chowdhury, Guiteras &
Mobarak (2015).
PROGRAMMATIC IMPLICATIONS 2: NEW IDEAS AND EXTENSIONS
• Find mechanisms to deliver
interventions when they will
coincide with major changes
in physical context or life
stage – e.g., promote OD
change through trained birth
assistants, midwives, and
antenatal clinics, etc.
www.wsp.org
• Strategic timing of
interventions so they occur
during or immediately
after large context changes,
especially changes that
impact cues directly involved
in OD (e.g., rainy season
altering accessibility of
habitual OD sites).
• Build new strategies that
can be deployed rapidly
during disease outbreaks
(e.g., Cholera) when people’s
existing behaviors are altered
(e.g., they stop shaking hands
and switch to the “Cholera
handshake”) and they are
actively thinking about hygiene.
9
The 8 Principles
Principle 3:
PIGGYBACK ON EXISTING CUES
AND BEHAVIORS
Principle Overview:
Relevance to OD:
Cues and behaviors that are already well established in
people’s daily practices can be linked to the new, desired
behavior. This increases the likelihood that the new
behavior is performed and is often more effective than
trying to insert a new behavior in isolation from existing
practices.
We found a number of challenges for Principle 3 in the
OD field research. In several states in India, OD is part of
a morning routine that includes a walk that is perceived
as pleasant and advantageous for overall well-being. OD
thus “piggybacks” on daily rituals of a time to walk,
check on crop fields, and socialize. For those working in
agriculture, especially in rural settings, OD is perceived as
typical behavior, natural or a part of the job since human
feces is commonly perceived as a fertilizer for crops. In
communities near rivers or bodies of water, OD may
piggyback on familiar or pleasant cues such as the feel or
sound of water or instant removal of waste.
Basic Science:
Instead of creating a new, desired behavior “from nothing,”
it can be more effective to attach the behavior to an existing
physical cue in the environment, or an existing behavior,
that is already established in people’s daily practice or
cultural understanding (Judah, Gardner, & Aunger, 2013).
HOW TO EXECUTE/EXAMPLES OF APPLICATION
Piggybacking on existing behavior:
• It is more effective to teach children to floss after
brushing (rather than before brushing) because this
sequence piggybacks the new behavior (flossing)
onto an existing habit (brushing). The existing habit,
thus, becomes a cue to automatically perform the
new behavior (Judah,
Gardner, & Aunger, 2013).
Piggybacking on
physical cues:
• Mrembo wash
station (picture to right)
has a mirror installed on
the front. The mirror is
aspirational and triggers
mirror-checking behavior,
which causes people
to engage with the
wash station.
10
There are potential opportunities to leverage Principle
3 from existing behaviors or activities. For example,
existing community routines and daily practices around
good hygiene could be leveraged to connect latrine use
to proper hygienic behavior. In Kenya, people who
maintain good hygiene are perceived to be healthier,
happier and confident, and are considered role models in
some communities (WSP report Kenya, 2013). Religious
or moral principles could also serve as piggybacking
opportunities. Bundling latrine construction with other
highly desired improvements in house may also be an
opportunity to piggyback on decisions or actions that have
already gained household momentum (Jenkins, 2005) or
are existing daily habits (see Programmatic Implications
below).
Nudging and Habit Change for Open Defecation: New Tactics from Behavioral Science
The 8 Principles
Piggybacking Challenges
Piggybacking Opportunities
• OD piggybacks on morning routine/walk.
• Opportunity to piggyback on existing behavioral
habits around good hygiene where those already
exist (e.g., connect latrine use to other hygiene
behaviors that may be more established in that
community – washing clothes, bathing).
• OD is inherent to some jobs such as working the
crops and using human feces as fertilizer.
• OD piggybacks on daily ritual of “time to talk,
walk and socialize”.
• Opportunity to piggyback latrine construction on
other home improvements.
• River OD involves many familiar/pleasant cues
(feel of water, instant removal of waste etc).
PROGRAMMATIC IMPLICATIONS 1: MAPPINGS TO RECENT INNOVATIONS/TACTICS
• If ritualized socializing is part of the OD habit
in a community, explore construction of café/
shaded area for socializing new public toilet
to maintain existing habit (see Principle 6 also).
For example, see the “Bloc Sanitaire”
experience in Madagascar and Ethiopia.
• Piggyback/bundle latrine construction
and upgrades onto other, already established
construction activities (such as annual roof
repairs or applications to have a water supply
connected to home).
• WaterAid innitiative in Nepal, piggyback
hygiene interventions onto successful
immunization programs.
PROGRAMMATIC IMPLICATIONS 2: NEW IDEAS AND EXTENSIONS
• Build community latrines that also support
other, already established daily routines such
as water gathering, washing of clothes, or
socializing. Latrine use can then piggyback on
these established, daily behaviors.
www.wsp.org
• Piggyback voucher systems for latrine
construction onto antenatal care visits.
11
Principle 4:
REDUCE PERCEIVED AND ACTUAL
FRICTION FOR NEW BEHAVIOR / ADD
FRICTION TO THE OLD
Principle Overview:
Basic Science:
Eliminate even minor amounts of choice, effort, and
decision-making or “friction” required to perform the
new (desired) behavior and/or add friction to the existing
(undesired) behavior.
When a new behavior requires even small amounts of
effort, decision-making or added steps (especially compared
to the status quo), relapse to old ways of acting will be
much more likely (Murray & Häubl, 2007). Conversely,
the likelihood of disrupting existing (undesired) behaviors
can be increased by adding friction.
HOW TO EXECUTE/EXAMPLES OF APPLICATION
Relevance to OD:
Removing friction from desired behaviors
• New medication management systems provide
patients with their
personal daily
medications presorted, thus removing
much of the friction
(decision-making,
multiple steps) usually
required to adhere to a
medicate regimen.
Adding friction to undesired behaviors
• When smoking
bans were
introduced in UK
pubs, people
with strong habits
to smoke while
drinking were no
longer able to
effortlessly light a
cigarette when they
felt the urge. The
resulting behavioral
friction (needing to
leave the pub to smoke) is thought to have disrupted
the automated association between drinking and
smoking and, in turn, helping to reduce smoking
rates (Orbell & Verplanken, 2010).
12
The convenience—or lack of friction—associated with OD
is a commonly cited factor that maintains the behavior.
In India, for example, common OD locations, such as
agricultural fields while working, are viewed as easily
accessible and natural places to practice OD. Rivers or
bodies of water that are easy to access make OD simple,
convenient and easy to dispose of waste (O’Connell,
2014) and thus pose minimal friction for practicing OD.
Perceived and actual maintenance requirements of latrines
can also generate friction to building or using latrines since
cleaning, repairing, and maintaining the superstructure
and emptying the pit are commonly cited disadvantages
or barriers to latrine use or construction (Tyndale Biscoe,
2013, WSP report for Kenya, Malawi, Meghalaya).
Despite these challenges, there are opportunities to
leverage Principle 4 in development of sanitation products.
Sanitation facilities that exhibit desirable qualities, such
as being easy to use, easy to maintain and clean, easy to
access, usable at all year and times of day, could decrease
the perceived or actual friction to using a latrine. In
addition to physical or structural attributes, behavioral or
emotional components can be leveraged to increase friction
for undesirable behavior, such as OD. For example, the
shame of a long walk to engage in OD can be used to cause
friction for practicing OD.
Nudging and Habit Change for Open Defecation: New Tactics from Behavioral Science
The 8 Principles
Friction Challenges
Friction Opportunities
• The process of building a latrine is often
multi-step, requiring a range of products sourced
from different locations. This creates many
opportunities to abandon the process. Common
OD locations are easily accessible/lack friction
(e.g., fields while working).
• Current OD behavior sometimes involves
significant effort/friction (e.g., having to carry
water for anal cleansing). This friction could
be exploited to drive latrine use (e.g., see
Programmatic Implications below).
• River OD is especially “frictionless” because the
experience is pleasant/waste “disappears”.
• Latrine maintenance generates friction through
cleaning/pit emptying. This friction may trigger
relapse to OD.
PROGRAMMATIC IMPLICATIONS 1: MAPPINGS TO RECENT INNOVATIONS/TACTICS
• Development of “Easy
Latrines” in Cambodia,
which pre-packages all
required elements for a
working latrine in an easyto-self-install design.
• Offering routine pit emptying
services that reduce the friction
associated with maintenance,
thus reducing the likelihood
that users abandon the latrine
and revert to OD.
• Include desirable, “easy”
product attributes (close
proximity, usable all year and
all times of day).
• Identify the “smallest
do-able action” (SDA) that is
easy to implement and will
have the largest impact on
the key outcome (e.g., Alive &
Thrive/FHI 360 identified “do
not give water” as the highest
impact SDA to promote
exlcusive breastfeeding in
Vietnam. Communications
were then targeted narrowly
and successfully to change
this specific SDA (see
Jimerson, 2016).
PROGRAMMATIC IMPLICATIONS 2: NEW IDEAS AND EXTENSIONS
• Explore the potential of simple heuristics/
rules that increase the distance people feel they
need to walk to engage in OD (e.g., a simple
“1000 step” rule would be easy to remember
and may add significant friction to OD).
www.wsp.org
• In locations where anal cleansing with water
is common, develop latrines that provide easy
filling of water pots, making latrine use less
burdensome than carrying water for OD.
13
The 8 Principles
Principle 5:
SUPPORT CONTEXT-STABLE REPETITION
Principle Overview:
Relevance to OD:
Where possible, encourage context-stable repetition.
Context-stable repetition can include repeating the desired
behavior in the same physical setting, at same time of day,
or in same action sequence. This can be enhanced through
implementation intentions.
Several of the WSP reports indicated that seasonal changes,
especially rainy season, affect the OD practice. Seasonal
changes present challenges for Principle 5 because the
context in which sanitation behaviors are performed are
not stable (changes in access, availability, comfort, safety).
Other challenges to a stable context for latrine use are
poor latrine construction (Tyndale, Biscone, 2013) and
degradation of the latrine structure. Both change the
context for latrine use and disrupt consistent practice or
revert back to OD. For example, a market assessment for
WSP in rural Malawi identified latrine durability (through
seasonal changes and natural degradation) as an important
barrier to latrine construction and reconstruction (WSP
Market Assessment for Rural Sanitation in Malawi, 2011).
Basic Science:
Habits are more likely to form when people not only repeat
frequently, but repeat in the same setting, at the same time
of day and/or in the same action sequence (Neal, Wood,
Labrecque, & Lally, 2012). This kind of repetition can
be promoted by implementation intentions instructions,
which require people to visualize/specify the particular
context in which they will perform the new/desired
behavior (Gollwitzer & Shearan, 2006).
HOW TO EXECUTE/EXAMPLES OF APPLICATION
• If people are
asked to form 5
specific “if-then
links” to support
fruit/vegetable
consumption, they
will be significantly
more likely to
carry out those
intentions/change
their behavior
(see Harris et al.,
2014). The if-then links must specify the particular
context or situational triggers for the behavior (e.g.,
respondent writes down: If I eat out during the day,
then I will have a banana after my food).
14
To support context-stable repetition, the literature we
reviewed highlighted opportunities around sanitation product
design and the context in which a sanitation facility would
be placed. Since proximity of the latrine was a commonly
cited barrier to use (mainly to due inconvenience or a
perceived waste of time to go to a latrine that was further
away than defecate in the open), placement of latrines near
the home but in an acceptable or culturally appropriate
place (e.g., away from sites of worship) could support
context stability. The WSP reports consistently indicated
that convenience, cleanliness, comfort, privacy, easy
maintenance, durability, and functionality through seasons
are key motivators for latrine adoption. While latrines
designed with a user-centered approach support a desirable
context for latrine adoption (Jenkins, 2005), they may also
support repetitive use in a desirable and stable context.
Nudging and Habit Change for Open Defecation: New Tactics from Behavioral Science
The 8 Principles
Context Stability Challenges
Context Stability Opportunities
• Poor latrine construction/need for frequent
maintenance reduces the opportunity to practice
context-stable usage of latrines.
• Latrine construction near home with
desirable attributes.
• Variable, limited opening times for public toilets
acts as barrier to context-stable usage.
• Seasonal changes can reduce context stability
of OD because people cannot engage in
the behavior at all times or at typical places.
PROGRAMMATIC IMPLICATIONS 1: MAPPINGS TO RECENT INNOVATIONS/TACTICS
• Develop incentive systems that reward users for using latrines at the same time of day and
same location (vs. incentivizing usage regardless of time and place). Reward systems of this
kind are being trialed via membership cards that work via RFID technology (which allows people’s
use of the latrine to be passively tracked without needing to swipe a card).
PROGRAMMATIC IMPLICATIONS 2: NEW IDEAS AND EXTENSIONS
• Examine the potential of “community toilets” (which may prioritize usage by many
users, but few use with sufficient frequency to form lasting habits). We note that, although
community toilets have high potential from a habit change perspective, they also carry
unique management challenges.
www.wsp.org
15
Principle 6:
ADDING “RITUALIZED” ELEMENTS
TO THE INTERVENTION CAN ENHANCE
EFFECTIVENESS AND ADVOCACY
Principle Overview:
Relevance to OD:
Where appropriate, promote inclusion of “ritualized
elements” in the new behavior or intervention process to
promote adoption.
From the qualitative reports in India, we know that certain
rituals can support OD. For example, the WSP reports
from communities in Bihar and Rajasthan reported OD as
a part of ritualized morning walks which were considered
pleasant, beneficial and supportive of well-being and
good bowel movement (WSP reports Bihar, Rajasthan).
However, creating new rituals could support better
sanitation behaviors. For example, creating new rituals
around purification or pride during public declarations of
ODF status can be an opportunity to leverage Principle 6.
Basic Science:
When behaviors become ritualized (i.e., linked with deep
personal or culturally relevant meaning) they can (a)
attract more attention/psychological engagement, (b) be
seen as more credible, (c) emotionally bind people to
each other around group-based values, and (d) be more
likely to be socially transmitted (Lienard & Boyer, 2006;
Rosano 2012).
HOW TO EXECUTE/EXAMPLES OF APPLICATION
Including a meaningful ceremonial component to an
action can elevate it to the status of a ritual, increasing
the likelihood that people perform the behavior.
Opportunities can be found to create cues/visible
signs of the ritual (e.g., ink on finger in elections).
16
In Bohol, Philippines, local fishermen were using
dynamite and cyanide to fish, leading to the rapid
destruction of the aquatic ecosystem. To curb this
behavior, statues of the Virgin Mary and other religious
figures were submerged around the reef system,
instantly bringing the behavior into conflict with deeply
held, religious and ritualized cultural themes.
Nudging and Habit Change for Open Defecation: New Tactics from Behavioral Science
The 8 Principles
Ritual-Building Challenges
Ritual-Building Opportunities
• Ritualized morning walks, which include OD, are
viewed as positive and pleasant.
• Opportunity to create rituals around purification/
pride and public declarations around ODF.
• “Filth” near home/close to religious or sacred
sites considered is already considered morally
wrong – this brings latrine use into conflict with
religious rituals.
PROGRAMMATIC IMPLICATIONS 1: MAPPINGS TO RECENT INNOVATIONS/TACTICS
• If ritualized socializing is part of the OD habit
in a community, explore construction of
café/shaded area for socializing new public toilet
to incorporate OD into an existing ritual.
• UNLI Rural Sanitation program in Phillipines
developed a simple hand gesture to
remind people/serve as a ritualized mnemonic
about the campaign.
PROGRAMMATIC IMPLICATIONS 2: NEW IDEAS AND EXTENSIONS
• In CLTS interventions, test ways to add a
plausible ritual element at the end of the transect
walk/ODF pledge. This ritual component could
symbolically capture the “end of OD” and the
transition point to ODF. Engage local religious/
traditional leaders to devise appropriate,
context-specific rituals (e.g., Hindus throwing
sindoor/Vermilion powder over common OD
sites to signal ritualistic purification).
www.wsp.org
• Integrate ODF thinking into major cultural
rituals including holidays, festivals (e.g.
reinforce the “no loo, no bride” association
around weddings).
17
The 8 Principles
Principle 7:
LEVERAGE REMINDERS
AND INTENTIONAL CUES
Principle Overview:
If people intend to engage in a behavior, remind them of
the behavior periodically, especially when they are in the
appropriate context.
Basic Science:
Following through on an intention requires a person
to remember the new behavior, but it is easy to forget
or neglect it. Reminders, especially in that appropriate
context, can mitigate forgetting (Cole-Lewis, & Kershaw,
2010; Elder, Ayala, & Harris, 1999; Fry, & Neff, 2009).
HOW TO EXECUTE/EXAMPLES OF APPLICATION
Telephone, email, text message, and postal
reminders for numerous behaviors, including diet,
physical activity, medication adherence and
smoking. Physical signs placed in locations where
the problem behavior is likely to occur. Signs can
leverage culturally powerful imagery.
Relevance to OD:
The aforementioned rituals or existing routines can
reinforce poor sanitation behaviors. For example, morning
walks that include OD among communities in certain
Indian states can serve as a cue or reminder to carry out
typical behavior (OD). Other cues within that context,
like the time of day or a sunrise, may also be cues for OD
practice.
Reminder & Cue Challenges
Reminder & Cue Opportunities
• Existing routines (e.g., the morning walk)
can serve as cue/reminder to carry out typical
behavior (OD).
• Opportunity to piggyback on religious cues that
signal OD is not acceptable in immediate
environment (e.g,, use of Arabic on walls near
common OD sites in Bangladesh).
• Time of day (e.g., sunrise) can serve as
cue/reminder to OD behavior.
18
Nudging and Habit Change for Open Defecation: New Tactics from Behavioral Science
PROGRAMMATIC IMPLICATIONS 1: MAPPINGS TO RECENT INNOVATIONS/TACTICS
• Incentive programs for latrine use can leverage text message reminders and can do
so using messaging schedules that are timed and framed to promote latrine usage at the
same time and place each day.
PROGRAMMATIC IMPLICATIONS 2: NEW IDEAS AND EXTENSIONS
• Clearly highlight traditional
OD places with adverse cues
(e.g., Hindus throwing sindoor/
Vermilion powder over OD sites
- see also Principle 6).
www.wsp.org
• To propote ODF status,
adapt interventions based
on the RANAS model that
combine public commitments
to wash with soap with
distinctive head scarves that
act as a stable cue to remind
people about adherence
(Contzen, Meili & Mosler, 2015).
• To propote ODF status,
adapt handwashing
interventions that place colored
footsteps from latrines to wash
stations (see Dreibelbis et al.,
2016), by painting colored
footsteps from common OD
sites to public toilets.
19
The 8 Principles
Principle 8:
LEVERAGE DESCRIPTIVE
AND “LOCALIZED” NORMS
Principle Overview:
Social norms are a powerful way to influence people’s
behavior. There are two major kinds of social norms (1)
Injunctive norms, which describe what people should do
(e.g., “most people think that smoking is unhealthy and
unattractive”) and (2) Descriptive norms, which describe
what most people actually do (e.g., “90% of people are
non-smokers”). Both can be effective at changing behavior,
but evidence suggests that descriptive norms may work in a
more automatic, effortless “System 1” way. Also, descriptive
norms can be made even more effective by framing them
using “localized” language that links to the actual context
and immediate circumstances of the intended audience.
Basic Science:
New research suggest that injunctive social norms are
effective primarily for people who can engage in some
degree of System 2 thinking (i.e., they can think about the
norm and engage in self-control). In contrast, descriptive
norms appear to work even when people cannot engage
System 2 thinking in this way. This is important, given
recent evidence that poverty acts like a “cognitive tax,”
limiting people’s ability to engage in effortful, System 2
thinking (Mani, Mullainathan, Shafir, & Zhao, 2013).
Thus, descriptive norms may be especially powerful and
under-leveraged as tools for driving behavior change among
the poor.
HOW TO EXECUTE/EXAMPLES OF APPLICATION
A sign in hotel rooms that stated, “75% of the
guests who stayed in this room participated in our
new resource savings program by using their towels
more than once” was more effective in promoting
re-use of hotel towels than a sign stating, “75% of
the guests participated in our new resource
savings program by using their towels more than
once” (Goldstein, Cialdini & Griskevicius, 2008).
20
So how can descriptive norms be optimally framed to
influence behavior? New research shows that descriptive
norms are most impactful when they are presented in a way
that matches the intended audience’s personal, immediate
circumstances (Goldstein, Cialdini & Griskevicius, 2008).
Thus, social norms are generally more successful if they
refer not to “people in general” but rather to people who
closely match the end user’s exact local circumstances (i.e.,
norms should be “localized”).
Relevance to OD:
Localized norms can pose challenges for stopping OD
and achieving consistent latrine use. We found a strong
perception that OD is “normal practice” in certain
communities among the literature we reviewed. In
a number of communities OD was reported as very
common, practiced for years and through generations,
normal and habitual (Coffey, Gupta, 2014; Patil, 2014;
WSP report Bihar, Indonesia, Kenya, Meghalaya,
Rajasthan).
However, there are several localized norms that might be
leveraged to improve sanitation behaviors. For example,
in Cambodia an advantage of owning a latrine is higher
social status and prestige (WSP report Cambodia, 2007)
and in Malawi improved social status was a key motivator
for latrine construction (WSP report Malawi, 2011).
Communities in East Java who have pride in collective
achievement were more likely than other communities
to achieve ODF outcomes (Mukherjee, 2011). In Bihar,
28% of cited pride and 45% cited honor as main reasons
for opting for toilets (WSP report Bihar, 2012). In a global
review of influencers of OD in rural settings, shame and
humiliation were cited in Peru, India, Tanzania and Kenya
as drivers of latrine to own, construct or reconstruct a
latrine (O’Connell, 2014). Each of these components
(pride, honor, shame, humiliation) reflect and depend on
local norms of respective communities and thus present as
opportunities to utilize Principle 8.
Nudging and Habit Change for Open Defecation: New Tactics from Behavioral Science
The 8 Principles
Normative Challenges
Normative Opportunities
• Strong perception that OD is the “normal
practice” in our community”.
• Achieving social status from latrine ownership
and reducing shame/increasing pride from OD are
strong drivers. These drivers reflect and depend on
the “local norms” of the community.
• Awareness that OD has been practiced for
generations, hence is accepted as local norm.
PROGRAMMATIC IMPLICATIONS 1: MAPPINGS TO RECENT INNOVATIONS/TACTICS
• Once OD behavior begins to change in an
intervention (e.g., post-triggering in CLTS),
develop new intervention activities that
highlight how the majority behavior has shifted,
reinforcing the new descriptive norm.
• Develop incentive systems that provide
rewards at the level of the local group (e.g.,
village, women’s groups) rather than individual
households, to create and reinforce a new
provincial norm around ODF status.
PROGRAMMATIC IMPLICATIONS 2: NEW IDEAS AND EXTENSIONS
• Construct public latrines at the “best schools” (creating an aspirational association) and fund
them to open early so that parents and children can use them during school drop-off and pick up
(see also Principle 1).
www.wsp.org
21
What
Concluding
Influences
Remarks
Open Defecation and Latrine Ownership in Rural Households?: Findings from a Global Review
III.
References
Concluding Remarks
In this report, we have advanced 8 System 1 Principles
that can be used to promote the initiation and
maintenance of behavior change around OD and
latrine use. Building on the World Bank’s 2015 World
Development Report: Mind, Society, and Behavior, the
principles were derived from basic science in social
psychology, cognitive science, behavioral economics, and
health psychology. Critically, we focused specifically
on “System 1” tactics that do not depend on the end
users’ rational, effortful decision-making or their
motivational systems (see Thaler & Sunstein, 2011;
Wood & Neal, 2015). Instead, we focused on ways to
disrupt existing OD habits and nudge people
automatically towards forming new, latrine use habits
that are maintained over time.
In closing, we reiterate that these 8 principles are designed
to augment, not replace, approaches based on System 2
thinking. As we have emphasized throughout, human
behavior is the product of both System 2 (rational,
motivated) and System 1 (automatic, cue driven habits).
Thus, the most powerful behavior change strategies are
likely to come from combining different intervention
tactics that, collectively, address both systems.
The 8 System 1 Principles to support OD behavior change
are as follows:
Finally, as field practitioners explore folding these ideas
into OD interventions, we encourage the use, where
practical, of randomized control trials (RCTs), the robust
measurement of outcome data, and the sharing of
successes and failures alike. In particular, we encourage the
sharing of new ways to translate, tailor, and “bring to life”
these basic science principles as makes sense in specific
environments, cultures, and sub-populations.
1. Ensure critical products and infrastructure are
immediately and consistently physically available for the
end user.
2. Create or capitalize on context change to drive
new behavior.
3. Piggyback on other existing behaviors and cues.
4. Address friction for the old and new behaviors.
5. Support context-stable repetition for latrine use.
6. Embed ritualized elements in the change process.
7. Leverage point-of-action reminders and cues, and,
8. Highlight descriptive and “localized” norms that
reduce cognitive demands.
22
Nudging and Habit Change for Open Defecation: New Tactics from Behavioral Science
Concluding Remarks
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